When Patch Adams met my mother.

In the end, she was free. She left us chained in memories. Her phone number now joins the list of other phone numbers that I can no longer call. Like the other earlier ones, this number also will not be deleted from my contacts.

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September 1982. My parents accompanied me to Mangalore as I was about to start my university life. More daunting than the engineering course to follow in the next four years, was the fact that I would move into a hostel! Though I had stayed with my relatives the previous six years, having left my home at a tender age of 11, it was still……..staying with my relatives, the setting was home.

Hostel appeared strange.

Intimidating.

For the first time in my life, I was going to be alone. I would be responsible for my life, my finance, my budget, my wellbeing, my laundry, my stuff……… MY LIFE! It was scary. But in hindsight, that was the best thing that happened to me. What I am today - my independence, my lack of displayed emotions, taking responsibility for my decisions – is the product of those four years. The youth was also wasted a little, reinforcing what Viet Thanh Nguyen said in his brilliant work, The Sympathizer.

January 2026. My brother and I took my mother to NESTRA HEALTH CARE for assisted living. Life comes a full circle. She needs round the clock care and attention. There had been a lot of debate, mainly driven by the social baggage, around what is right and acceptable. The prevailing wisdom was, the elders must be cared for at home.

Come what may!

I fail to see any logic or even compassion or commonsense in this. We are OK with admitting one’s mother, or for that matter anyone who is extremely unwell, into a hospital. This ailing person can spend a week in ICU, another week in the general ward, and when able, is brought back home. There is no drama or moral grounds on getting this person moved to the hospital and be left in the care of trained professionals. We are not sitting down and having a long drawn discussion on whether the person should move to a hospital; if it is the right thing to do; if we are somehow failing in our moral duties. Yada. Yada. Yada. It is the most obvious thing to do. If the care and health of the person can’t be provided at home, then the person is shifted to a place run and managed by professionals of health care.

What is OK for a hospital admission is apparently not OK for continued living.

What is complicated in this equation is, that at times the elders themselves are unreasonable. They feel that they have been “ dumped” at a place. That their children do not care for them anymore.

Fortunately, my mother is not one of them. She, in fact, wanted to move and made it clear that this is her choice and also not to nurse any thoughts of one day taking her back home.

“I go from here” is what she said.

She meant her trip to the crematorium.

There is another inane argument offered by the society. Your parents took care of you when you were young and you need to take care of them when they are old.

Absolutely correct.

Non-negotiable.

But who gets to define what is “ caring”. And who gets to define the “ quality” of the care.

Let us also factor in certain biological aspects. Your parents were young when you were a child. You are now in your 60s (probably) when they reach this stage of complete dependence.

It is OK for a Rajni to carry a Pandari Bai in his arms and sing a song, but real life is different.

PC: Google Images

Let us visualize the life of an elderly. A widow or a widower, especially. They have their room. With their meagre needs. A cot, a tab, their YouTube Vishnu Sahashranamams, Hanuman Chalisas, Kanda Sasthi Kavachams, their daily or weekly calls with their relatives, food at regular times, mostly consumed alone, as the others in the household are either away or their times do not match, their offspring(s) spending about 10 mins in the morning and 15 minutes in the evening with them. They spend most of their time lying down as sitting up is taxing and takes up too much efforts. They do not go out with the rest of the family for the same reason. They live in dread of falling down and breaking a bone or two. They know that this would be an additional burden to the family, more than their physical strain. They slow down.

This is applicable if they are mobile.

What should they do, should their dependency increase? Let us look at a situation where the person is bedridden, or mostly confined to bed, needs someone’s assistance to move about. They need oxygen virtually round the clock. They need additional machines that help them live. Put yourself in their place.

·       Every unassisted breath is a struggle

·       Every step is an eternity

·       A simple trip to the washroom becomes an act without dignity

·       The ever present fear that something will go wrong and that you will become an additional burden

·       Heightened sensitivity that exaggerates everything around you (usually in a negative way)

When such a position comes around and round-the-clock professional care is inevitable, the society and the relatives chip in.

“ All of this can be provided at home”

“ Why send her to assisted living”

“ They are flesh and blood people, not things, to use and discard after their usefulness”

There is a general reluctance to send an elderly to professional care, away from home. In all this deliberation and debates, the person who needs the care is not consulted. One takes a decision not to send them knowing very well that keeping them at home is at best a compromise and in reality a stupid one. People often take this decision to keep them at home with the conviction that solitude is unbearable.

On the contrary solitude is beautiful.

It is indifference that kills.

In my mother’s case, she knew her condition and she also knew the impossibility of continuing at home. She knew the risks she is exposing herself to as well as the demands on the others in the household.

A thousand things can go wrong.

·       There can be a power failure

·       There can be a fall

·       There may be no one around when an emergency occurs

The naysayers will argue that power can fail in the assisted living institute too, she may fall there too, she may be alone when an emergency occurs. It is quite possible but the probability of it happening is rather low. They are professionals.

Let me give you an example.

You are sitting down for dinner at home and tell your husband that you would like to have “ Methi Malai Mutter”. And you order the same dish in a restaurant. In which place are you likely to get the item on your table?

Professionals manage their operations differently and hence lesser chances of a mishap compared to an ordinary setting.

Twenty routine minutes each day in the known environs of home will look so insignificant when you spend two quality hours a week when you visit her. She will have a healthy routine, professional care, less guilt, more of the same routine. After all, what is/has been her routine? Get up, coffee, ablution, breakfast, flirt with her gods, lunch, sleep, calls to/from the regulars, special calls on specific days, an evening with Sai Baba, dinner and sleep.

Repeat.

None of this will change. She will make new friends. Young nurses will learn about her rich life. She will impart wisdom and she will learn from them.

This is not to say that she will not miss home. Of course, she will. At least initially.

With comfort comes vacillation.

When her needs are attended to, and when life falls into a predictable routine, she will start missing having the familiar surroundings, and people. Family by definition involves people, and that familiar connection of seeing the usual faces, or those festivals, gatherings will be missed. One’s mind at such an advanced age will not be able to assess and conclude that this is the best option available. If anything, human beings are adaptable. Her body will get used to the comfort and her mind will still long for undefined, undefinable emotions. Emotions are tricky. She herself will realize that any other option will be a compromise. Her heart will overrule her head. Only time could heal this conundrum. This is where we come in. To talk with her as frequently as possible. Visit her as much as we can. The care home and its staff play a vital role here. Her needs are meagre. And if the staff understands this and treat her with care and respect, she will have nothing to complain.

She may still need medical intervention. She may have to be shifted to a hospital for extra care that the home is unable to provide. This should not come as a shock. She may have to be shifted and brought back. We agree on certain basics. She will not be kept alive like a vegetable. We agree to a DNR, DNI and no ventilator.

We abide by what David Clayton-Thomas sang in “When I Die” – ‘ If it’s peace you find in dying, well, then let the time be near’ and ‘all I ask of dying is to go naturally’.

When a WhatsApp forward comes that says “ In the end, it’s not the years in your life that count. It’s the life in your years” , we agree and immediately forward it to others in our contacts. But we will not allow the dignity of an older person to go and live in the way they would prefer. We will make their decisions for them. We will convince them that they are happy at home. We will convince ourselves that we are doing the right thing. They are likely to be sad and in pain. We are likely to be impatient and irritated. But we are doing the right thing because that is how the society is going to judge us. Like Kevin Simler said in his fantastic book, - The elephant in the brain -  “we deceive ourselves in order better to deceive others”.

Patch Adams said it most succinctly “Our job is improving the quality of life, not just delaying death”

Video from YouTube

We know we have done the right thing by moving my mother to assisted living. This is what she deserves in her last days. We are only glad that we could make it happen. She may have a few more months or years left. We have no idea. We count every additional day as a blessing.

One should be prepared to accept that every message (our care home made a WhatsApp group to post updates) and every phone call makes your heart race. When your time is coming to an end, the inevitable will happen one day, and not knowing if that day is today or has already happened is nerve wracking. One had to endure. There are no easy way out here.

I am talking to her more regularly than ever. Two calls a day. Not just me, her schedule is loaded like a calendar of a fortune 500 CEO. At least six daily calls, few weekly calls, and about two or three visits a week by my friends and relatives who live in the city or visiting the city. My wife , who has now become an expert in remote monitoring, has been busy with the cook and in explaining to him some specific recipes.

There is truth in the saying that absence makes the heart grow fonder even if proximity breeds contempt does not apply here.

Moving an elderly person to assisted care is more difficult in India (and may be in Asia in general) than in many of the western countries. Not because of lack of facilities. There are plenty. They are professionally managed too. It is true, that the services offered are not exactly what they are “advertised-as” in many places. But, overall, one could have no complaints. The hurdle is social and behavioral. There is a general reluctance to opt for such facilities, when commonsense screams it loud as the only logical option, mainly due to societal baggage. One is worried about what the society will say and how they will judge you. This was never relevant nor is it relevant today. But surprisingly it is a single major point of contention in opting for a logical option against a misplaced compromise that makes life difficult for everyone concerned.

Please choose the place well. There are the usual compulsions of cost and proximity. I would recommend the following checklist.

1.       Visit the place in person – do not go by brochures.

2.       Look at the facilities that are on offer

3.       The following are the top ones.

a.       Food

b.       Quality of the attendant

c.       In-house doctor

d.       Qualified nurses

4.       If the person can soak in the sun

5.       Small walks

6.       Proximity.

7.       Wi-Fi connectivity

8.       Visiting hours – are they flexible or too formal.

One will not visit them every day. But when one wants to, the procedure should not be too bureaucratic. 

As if to vindicate our stand, she has been going on a regular walk on the terrace where she gets the sun, or along the corridor if it is too cold outside. She even goes down a floor and visits the small Ganesha Temple inside the gate of the premises.

Photo shared by a Nestra Staff.

Many will not agree with our decision. They have their reasons.

We were clear and so was our mother. And that’s all that matters in the end. All hysteria around providing expert care to the elderly need to die down.

If a hostel to a college going student is accepted, a care home for the elderly should not raise eyebrows or pass judgments on character.

Care home for elderly should be normalized.

It should be the norm and an obvious choice when keeping them at home is a strain on them and you.

If this article helps even one person in making that decision, my purpose is served.

And finally, a shout out to Nestra and the people there. On a macro scale, this was service. It could have remained that way, impersonal, clinical and matter of fact. But the staff at Nestra treated our mother with passion, kindness and care. She was pampered. And to that, I say a big THANK YOU to all at Nestra. You made sure her final days were pleasant and as less painful as possible. You were firm but were also kind. Bless you!

Mother once said “These children take care of me so much. They keep me engaged, ask me what would I like to have for breakfast, lunch and dinner. They force me to eat even when I am not inclined to eat. “

You people are indeed great.

Here I name you all. Please know that my family is forever indebted to you.

Thanks Ganga, Smrity, Swarna, Deepa, Rubina, Simran, Rubi, Ratan, Palani, Dr .Hajira, Dr. Malathi, and Veena!

I shudder to think how we would have managed her at home. The care provided by Nestra was exemplary and exceptional. Our heart would have willed, but we would have been severely handicapped in our ability to manage her needs. Both physical and medical.

This was her family in the last few months of her life. And to that, we are eternally grateful.

Photo shared by a Nestra staff

And in the end, a salute to my cousin, Manju Meena who is a perfect definition of selfless, dedicated, complete, and pure love.